Provider Demographics
NPI:1811944481
Name:DOISY, KATHLEEN M (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:DOISY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:3217 S PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3639
Practice Address - Country:US
Practice Address - Phone:573-882-4730
Practice Address - Fax:573-884-5226
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO370018322OtherRR MEDICARE
MO384381OtherHEALTHLINK
MO2087193601OtherKANSAS MEDICAID
MO209789510Medicaid
MO1201063OtherUNITED HEALTHCARE
MO114484OtherBLUE SHIELD/BLUE CROSS
MO370018322OtherRR MEDICARE
MO209789510Medicaid
MO114484OtherBLUE SHIELD/BLUE CROSS